OAHU BOULDERING GYM, LLC RELEASE OF LIABILITY AND ASSUMPTION OF RISK

OAHU BOULDERING GYM, LLC
RELEASE OF LIABILITY AND ASSUMPTION OF RISK

I, the undersigned, understand that in consideration of using the facilities, climbing walls, equipment and/or participating in activities of Oahu Bouldering Gym, LLC (“OBG”), I must obey all rules and regulations of OBG regarding indoor rock climbing and its programs. I acknowledge that indoor rock climbing entails inherent risks such as death, injury, paralysis, and damage to myself, to property, or to third parties, including but not limited to: equipment failure, falling climbers, broken and/or falling holds, loose holds, the negligence of OBG or its agents, the negligence of guests or visitors of OBG, the negligence of the designers, manufacturers, or installers of the indoor rock climbing wall or its equipment, the negligence of the belayers, slips, falls, or collisions or other such actions occurring while using the indoor rock climbing wall. I am solely responsible for my own safety and well-being, and represent that I am in good health, physical, and mental condition that renders me capable of participating in the Activities (defined below).

I hereby voluntarily release and forever discharge OBG from any and all liability, and agree to indemnify and forever hold harmless OBG from any and all claims, liabilities, demands, or causes of action, including any claims which I, my heirs, next of kin, assigns, estate, or personal representatives have or may have, which are in any way connected with my participation in indoor rock climbing, or any activities of OBG, or use of its equipment or facilities (collectively the “Activities”).

I expressly agree and promise to accept and assume all of the risks existing in these Activities, both known and unknown, whether caused or alleged to be caused by the ordinary negligence or omissions of OBG. I realize that by voluntarily assuming the risks involved, I will be solely responsible for my death or any injury or damage that I may sustain.

I certify to that I am at least eighteen (18) years of age or older, physically and mentally capable of safely participating in indoor rock climbing and that any personal belayer and equipment that I use as part of my climb are appropriate and properly qualified for my climb. I further certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating in these Activities and I am willing to assume and bear the costs of all risks that may arise from these Activities.

I HAVE HAD SUFFICIENT OPPORTUNITY TO READ THIS ENTIRE DOCUMENT.

I HAVE READ AND UNDERSTOOD IT, AND I AGREE TO BE BOUND BY ITS TERMS.

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Please select who will be participating...

Adult Minor(s)Adult and Minor(s)
1 Minor 2 Minors 3 Minors 4 Minors 5 Minors More Minors 6 Minors 7 Minors 8 Minors 9 Minors 10 Minors

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First Participant's Name

First Name*

Middle Name

Last Name*

Phone*

First Participant's Date of Birth*

First Participant's Medical History

Please list any and all medical conditions which may affect your ability to participate in the Activities (e.g. heart conditions, recent operations, physical injuries, etc.):

If you decline to list your medical history, please initial here:

Despite the foregoing medical conditions, you are expressly agreeing to participate in the Activities and agree to the terms herein.*

Yes

First Participant's Signature*

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Second Participant's Name

First Name*

Middle Name

Last Name*

Second Participant's Date of Birth*

Second Participant's Medical History

Please list any and all medical conditions which may affect your ability to participate in the Activities (e.g. heart conditions, recent operations, physical injuries, etc.):

If you decline to list your medical history, please initial here:

Despite the foregoing medical conditions, you are expressly agreeing to participate in the Activities and agree to the terms herein.*

Yes

Third Participant's Name

First Name*

Middle Name

Last Name*

Third Participant's Date of Birth*

Third Participant's Medical History

Please list any and all medical conditions which may affect your ability to participate in the Activities (e.g. heart conditions, recent operations, physical injuries, etc.):

If you decline to list your medical history, please initial here:

Despite the foregoing medical conditions, you are expressly agreeing to participate in the Activities and agree to the terms herein.*

Yes

Fourth Participant's Name

First Name*

Middle Name

Last Name*

Fourth Participant's Date of Birth*

Fourth Participant's Medical History

Please list any and all medical conditions which may affect your ability to participate in the Activities (e.g. heart conditions, recent operations, physical injuries, etc.):

If you decline to list your medical history, please initial here:

Despite the foregoing medical conditions, you are expressly agreeing to participate in the Activities and agree to the terms herein.*

Yes

Fifth Participant's Name

First Name*

Middle Name

Last Name*

Fifth Participant's Date of Birth*

Fifth Participant's Medical History

Please list any and all medical conditions which may affect your ability to participate in the Activities (e.g. heart conditions, recent operations, physical injuries, etc.):

If you decline to list your medical history, please initial here:

Despite the foregoing medical conditions, you are expressly agreeing to participate in the Activities and agree to the terms herein.*

Yes

Sixth Participant's Name

First Name*

Middle Name

Last Name*

Sixth Participant's Date of Birth*

Sixth Participant's Medical History

Please list any and all medical conditions which may affect your ability to participate in the Activities (e.g. heart conditions, recent operations, physical injuries, etc.):

If you decline to list your medical history, please initial here:

Despite the foregoing medical conditions, you are expressly agreeing to participate in the Activities and agree to the terms herein.*

Yes

Seventh Participant's Name

First Name*

Middle Name

Last Name*

Seventh Participant's Date of Birth*

Seventh Participant's Medical History

Please list any and all medical conditions which may affect your ability to participate in the Activities (e.g. heart conditions, recent operations, physical injuries, etc.):

If you decline to list your medical history, please initial here:

Despite the foregoing medical conditions, you are expressly agreeing to participate in the Activities and agree to the terms herein.*

Yes

Eighth Participant's Name

First Name*

Middle Name

Last Name*

Eighth Participant's Date of Birth*

Eighth Participant's Medical History

Please list any and all medical conditions which may affect your ability to participate in the Activities (e.g. heart conditions, recent operations, physical injuries, etc.):

If you decline to list your medical history, please initial here:

Despite the foregoing medical conditions, you are expressly agreeing to participate in the Activities and agree to the terms herein.*

Yes

Ninth Participant's Name

First Name*

Middle Name

Last Name*

Ninth Participant's Date of Birth*

Ninth Participant's Medical History

Please list any and all medical conditions which may affect your ability to participate in the Activities (e.g. heart conditions, recent operations, physical injuries, etc.):

If you decline to list your medical history, please initial here:

Despite the foregoing medical conditions, you are expressly agreeing to participate in the Activities and agree to the terms herein.*

Yes

Tenth Participant's Name

First Name*

Middle Name

Last Name*

Tenth Participant's Date of Birth*

Tenth Participant's Medical History

Please list any and all medical conditions which may affect your ability to participate in the Activities (e.g. heart conditions, recent operations, physical injuries, etc.):

If you decline to list your medical history, please initial here:

Despite the foregoing medical conditions, you are expressly agreeing to participate in the Activities and agree to the terms herein.*

Yes

Participant's Address

Address Line 1:*

Street address, P.O. box, company name, c/o

Address Line 2:

Apartment, suite, unit, building, floor, etc.

Country:*

City:*

State/Province:*

Zip/Postal:*

Parent or Guardian's Email Address

Email*

Confirm Email*

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Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*

IF PARTICIPANT IS UNDER 18 YEARS OF AGE, PARENT OR LEGAL GUARDIAN MUST COMPLETE THE FOLLOWING: I am the parent or legal guardian of (“Minor”), and hereby execute this Release for an on behalf of Minor and agree to bind myself, Minor, and any heirs, next of kin, assigns or personal representatives to the terms of this Release. I represent that I have full legal authority to act for and on behalf of Minor and I agree to indemnify and forever hold harmless OBG for any expenses, claims, or liabilities which may arise as a result of any insufficiency of my full legal authority to execute this Release.

By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.

Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*

Parent or Guardian's Date of Birth*

Parent or Guardian's Medical History

Please list any and all medical conditions which may affect your ability to participate in the Activities (e.g. heart conditions, recent operations, physical injuries, etc.):

If you decline to list your medical history, please initial here:

Despite the foregoing medical conditions, you are expressly agreeing to participate in the Activities and agree to the terms herein.*

Yes

Parent or Guardian's Signature*

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Electronic Signature Consent*

By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.

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